Tuesday, January 7, 2014: 1:45 PM
Royal Pavilion Ballroom I-III (The Regent Hotel)

Angela Fagerlin, PhD1, Margaret Holmes-Rovner, PhD2, Sara J. Knight, PhD3, Bruce Ling, MD, MPH4, Stewart Alexander, PhD5, James A. Tulsky, MD5, David Rovner, MD6, Valerie C. Kahn, MPH7 and Peter A. Ubel, MD5, (1)VA Ann Arbor Healthcare System & University of Michigan, Ann Arbor, MI, (2)Center for Ethics, E. Lansing, MI, (3)Department of Veterans Affairs, Washington, DC, (4)University of Pittsburgh, Pittsburgh, PA, (5)Duke University, Durham, NC, (6)Michigan State University, East Lansing, MI, (7)University of Michigan, Ann Arbor, MI
Purpose: The role of physicians in medical decisions is critical and it is important to understand how patients’ interactions with their physicians affect their treatment preferences and their perception of the decision making process.

Method: 1015 men were recruited from 4 VA hospitals immediately after receiving a biopsy for suspicion of prostate cancer. Men received an education intervention and completed 3 surveys: at their biopsy, immediately before receiving their cancer diagnosis, and one week following diagnosis. Only patients with a positive biopsy result indicating localized prostate cancer (PSA<20, Gleason score of 6-7) were eligible to complete Time 2 and 3 surveys (N = 335). Key measures included the COMRADE (combined outcome measure for risk communication and treatment decision making effectiveness), the PICS (Perceived Involvement Scale), perceptions of physician recommendations, and treatment preferences and treatment received.

Result: Overall, patients reported high satisfaction with their physician and their communication with their physician (Ms=4.25 and 4.43 on COMRADE Subscales and M=0.73 on PIC doctor facilitation subscale). Neither race, education, literacy, nor numeracy predicted patients’ satisfaction with their physician. Higher scores on PICS predicted more desire for a strong physician role in decision making (and thus less patient role in decision making; B=-0.14, p=0.03).

   Patients indicated that they believed that it is very important to undergo the treatment that their doctor thinks is best for them (M=8.6 on a 10-point scale). 73.8% of patients received a treatment recommendation from their urologist (45.0% of the recommendations were for surgery, 3.3% for radiation, and 32.8% for active surveillance). Patients indicated that the recommendations were moderately strong (M=3.8 on 5-point scale) and were moderately influential on their treatment decision (M=3.7 on 5-point scale). 

   After talking to their doctor about their treatment choices, the only factors that influenced the treatment patients’ received was their physicians’ recommendations (factors not influential included race, numeracy, literacy, patients’ own treatment preferences, knowledge).

Conclusion: Physicians play an important role in patients’ decisions, both by self-report and as reflected in the patients’ actual treatment decisions. Patients’ reported high satisfaction with their interaction with their urologists and believe that their recommendations play a role in their decision making process. However, there is concern that patients’ values may not be reflected in decisions given the strong impact of physicians’ recommendations.